El género epistolar en la prensa como visión ciudadana de la esfera pública en Colombia

A partir de un análisis temático inductivo, este artículo explora la visión ciudadana sobre la esfera pública expresada en las cartas de los lectores de los diarios El Tiempo y El Heraldo de Colombia. Los resultados muestran cómo la identidad colectiva de los lectores apareció en forma transversal en las cartas, para dar cuenta de una comunidad de adultos que se autodefine como “colombianos de bien”. El análisis reveló dos unidades de significado: posturas sobre la administración de lo público y antagonismos en la esfera pública, centrada en el conflicto político con las guerrillas. A través de estas se pudieron hacer visibles los llamamientos vívidos de los lectores al gobierno, funcionarios públicos, actores al margen de la ley y a sus compatriotas, para movilizarse para exigir cambios sociales largamente esperados.

Outlier effects on robust joint modelling of longitudinal and survival data

Robust joint modelling is an emerging field of research. Through the advancements in electronic patient healthcare records, the popularly of joint modelling approaches has grown rapidly in recent years providing simultaneous analysis of longitudinal and survival data. This research advances previous work through the development of a novel robust joint modelling methodology for one of the most common types of standard joint models, that which links a linear mixed model with a Cox proportional hazards model. Through t-distributional assumptions, longitudinal outliers are accommodated with their detrimental impact being down weighed and thus providing more efficient and reliable estimates. The robust joint modelling technique and its major benefits are showcased through the analysis of Northern Irish end stage renal disease patients. With an ageing population and growing prevalence of chronic kidney disease within the United Kingdom, there is a pressing demand to investigate the detrimental relationship between the changing haemoglobin levels of haemodialysis patients and their survival. As outliers within the NI renal data were found to have significantly worse survival, identification of outlying individuals through robust joint modelling may aid nephrologists to improve patient's survival. A simulation study was also undertaken to explore the difference between robust and standard joint models in the presence of increasing proportions and extremity of longitudinal outliers. More efficient and reliable estimates were obtained by robust joint models with increasing contrast between the robust and standard joint models when a greater proportion of more extreme outliers are present. Through illustration of the gains in efficiency and reliability of parameters when outliers exist, the potential of robust joint modelling is evident. The research presented in this thesis highlights the benefits and stresses the need to utilise a more robust approach to joint modelling in the presence of longitudinal outliers.

Charte canadienne et droits linguistiques : frontières allégoriques et autres assertions consensuelles

La frontière entre le politique et l'intellectualisme militant est, d'ordinaire, ténue. Tout univers politico-constitutionnel est ainsi susceptible de faire les frais d'un martèlement doctrinal qui, à maints égards, relève davantage du construit que du donné. Résultante directe d'une construction parfois intéressée, le récit identitaire, à force de répétition, s'installera confortablement sur les sièges de l'imaginaire populaire. Il accèdera, au fil du temps, au statut de mythe pur et simple. Ce dernier, politiquement parlant, revêt de puissants effets aphrodisiaques. La présente thèse doctorale s'intéresse plus particulièrement aux mythes créés, depuis 1982, par un segment de la doctrine québécoise : en matière de droits linguistiques, objet principal de notre étude, Charte canadienne des droits et libertés et Cour suprême, toutes deux liguées contre le Québec, combineront leurs efforts afin d'assurer le recul du fait français dans la Belle Province. Quant aux francophones hors Québec, ceux-ci, depuis l'effritement du concept de nation canadienne-française, sont dorénavant exclus de l'équation, expurgés de l'échiquier constitutionnel. En fait, l'adoption d'un nationalisme méthodologique comme nouvelle orthodoxie politique et doctrinale rend ardue, en plusieurs sens, la conciliation de leur existence avec les paradigmes et épistémologie maintenant consacrés. Ainsi, et selon la logique du tiers exclu, une victoire francophone hors Québec signifiera, du fait d'une prétendue symétrie interprétative, un gain pour la communauté anglo-québécoise. Cette thèse vise à discuter de la teneur de diverses allégories établies et, le cas échéant, à reconsidérer la portée réelle de la Charte canadienne en matière linguistique. Il sera alors démontré que plusieurs lieux communs formulés par les milieux intellectuels québécois échouent au moins partiellement, le test de l'analyse factuelle. Celui-ci certifiera de l'exclusion, par la doxa, de toute décision judiciaire ou autre vérité empirique ne pouvant cadrer à même les paramètres, voire les prismes, de l'orthodoxie suggérée.

Estudo sobre a Transferência da Formação na EFAPEL, S.A.

O presente trabalho de investigação pretendeu estudar e avaliar a transferência da formação para o local de trabalho e os seus impactos ao nível das alterações no desempenho dos colaboradores da EFAPEL, S.A. De forma a tornar possível esse objetivo, o estudo procurou apoiar-se nos pressupostos teóricos que sustêm um projeto desta natureza. Abordando a transferência da formação no contexto organizacional, procurou-se determinar quais os fatores que afetam a mesma para o local de trabalho e para a função desempenhada. Neste sentido, e considerando as três dimensões que influenciam a transferência da formação, o presente estudo pretende, de alguma forma, ser um contributo para um melhor conhecimento da transferência da formação através, da análise empírica de como determinadas variáveis relacionadas com as características individuais, as características da conceção da formação e com as características organizacionais, influenciam a transferência da formação. Os resultados obtidos indicam-nos que os fatores identificados como os que mais influenciam a transferência da formação são, sem dúvida, os fatores organizacionais, o que indica que a cultura e as práticas da organização são decisivas na transferência e eficácia da formação. Deseja-se que os resultados obtidos na investigação contribuam para a melhoria e ajustamentos no processo de gestão e implementação da formação na EFAPEL, S.A., com ganhos de eficiência e eficácia. / This research work was to study and evaluate the transfer of training to the workplace and their impacts in terms of changes in the performance of employees EFAPEL, SA. In order to make this goal possible, the study sought to build on the theoretical assumptions that sustain a project of this nature. Addressing the transfer of training in the organizational context, we sought to determine which factors affect the same for the workplace and for the function performed. In this sense, and considering the three dimensions that influence the transfer of training, the present study intends to somehow be a contribution to a better knowledge transfer through training, the empirical analysis of how certain variables related to individual characteristics, the characteristics of the design of training and organizational characteristics influence the transfer of training. The results show us that the factors identified as those that most influence the transfer of training are undoubtedly organizational factors, indicating that the culture and practices of the organization are crucial in the transfer and training effectiveness. It is hoped that the results obtained in the research will contribute to the improvement and adjustments in management process and implementation of training in EFAPEL, SA, with gains in efficiency and effectiveness.

Inserção de fornecedores locais como fonte de desempenhos em custos de transação e legitimidade: estudo de caso na cadeia produtiva do petróleo e gás do Rio Grande do Norte

The inclusion of local suppliers in production chains has considerable impact on its performance, but most notably in its main actors. The results of this process may be of different kinds and can be analyzed from economic or institutional approaches. This study aimed to verify the existence of different performances of Petrobras due to the inclusion of local suppliers in the oil and gas production chain in the state of Rio Grande do Norte, from the viewpoints of transaction costs and the Institutional Theory. In order to this, were made the characterization of the PROMINP, the description of its actions and results, the mapping of its institutional context of reference, and identification of results obtained by Petrobras in terms of transaction costs and legitimacy. The theoretical framework is based on authors dealing with industrial concentration, as like Marshall, Krugman, Porter and Schmitz, from the sociological perspective of neoinstitucional theory, as like DiMaggio and Powell and Scott and Meyer, and transaction costs, as like Williamson. This is a qualitative research, with data collection done by consulting secondary fonts and semi-structured interviews with nineteen actors of three groups, namely: actors involved in actions of the program, representatives of enterprises and representative of Petrobras. To analyze the content was used the Suchman s model (1995) for categories associated with strategies of legitimation and fourteen variables associated with the three variables assets specificity, bounded rationality and opportunism (Williamson, 1995, 1989) in the case of transaction costs. The results indicate that PROMINP has achieved its objectives by encouraging the increased participation of local companies in the oil and gas production chain, reflecting in the economic development of the state. The Redepetro/RN, fostered and built upon the interaction of the participants, is presented as a solution of continuity to the participation of enterprises in the chain, after the closure of the actions of the program. PROMINP demands responses to coercive, legislative and regulatory pressures of the organizational field, whose institutional context of reference is wide. From the point of view of legitimacy, through strategies to gain cognitive legitimacy and maintaining pragmatic legitimacy, Petrobras can manipulate the environment, ensuring the compliance of the constituents to their technical and institutional demands. Enterprises, in turn, respond to the demands through compliance with technical demands, mainly through the certification of processes, and cultural changes. There aren t clear gains related to the transaction costs, however, gains in legitimacy can be seen as a cumulative capital that can serve as a competitive differential that generates economic gains. In terms of theoretical findings, it was found that, due to its explanatory power for actions that are difficult to explain only in economic terms, Institutional Theory may be used as theoretical support concurrent with other theories. TCE model has limitations in explaining the program actions. In the case, it s emphasized that Petrobras doesn t seek only economic efficiency, but has in its mission the commitment to social development.

Étude exploratoire auprès de médecins des effets perçus d’une formation corps / esprit fondée sur les pratiques du Sensible

Résumé: Les pratiques du Sensible sont des pratiques d’accompagnement formatives et soignantes. Elles permettent d’apprendre comment l’expérience du corps et de son mouvement interne conduit au développement de la conscience et de la présence à soi ainsi qu’à l’autre, des qualités enviables pour des professionnelles et professionnels de la relation d’aide du secteur de la santé. Dans ces pratiques, le corps joue un rôle central à travers quatre types d’intervention : la thérapie manuelle, la gymnastique sensorielle, l’introspection sensorielle et l’entretien verbal à propos de l’expérience corporelle. Selon Large (2009), une qualité de présence particulière se construit chez les participantes et le participant aux pratiques du Sensible. Selon lui, ceux-ci se rapprochent de leur intériorité, parviennent à verbaliser à autrui ce qu’ils ressentent et en arrivent à poser des actions qui expriment ce qu’ils deviennent. Large (2009) constate qu’ils acquièrent de la stabilité, de l’adaptabilité et de l’autonomie. À la fois plus affirmatifs, ils gagnent aussi en proximité à l’autre. Bois (2007) note un changement de représentation lié aux idées, aux valeurs, à l’image de soi et au rapport perceptif à soi. Une chercheure et des chercheurs constatent un changement de conception de la santé (Duval, 2010; Laemmlin-Cencig et Humpich, 2009). À notre connaissance, il n’y a pas eu d’étude antérieure concernant l’influence des pratiques du Sensible auprès de médecins. Nous avons exploré, le cas échéant, comment une formation aux pratiques du Sensible, suivie par des médecins, a modifié leur rapport à leur corps, à leur propre santé, à leur conception de la santé, à la qualité de leur présence à eux-mêmes, aux autres professionnelles et professionnels et aux patientes et patients. Des entretiens semi-structurés d’une durée de 90 à 105 minutes ont été effectués auprès de six médecins français (cinq femmes et un homme) ayant été formés aux pratiques du Sensible entre 2005 et 2012. Deux types d’entretiens à visée compréhensive (Kaufmann, 2011) et d’explicitation (Vermersch, 2010; 2012) ont été réalisés. Des informations ont aussi été recueillies sur la formation et les activités professionnelles des participantes et du participant. Deux démarches d’analyse ont été utilisées, entre autres pour vérifier la cohérence des résultats et augmenter la rigueur de notre projet. Notre première démarche d’analyse a été conçue à partir de deux méthodes : au départ avec l’analyse thématique et par la suite une analyse avec les catégories conceptualisantes afin de déboucher sur une théorisation ancrée. La deuxième démarche d’analyse a consisté à créer une liste de vingt-six phénomènes présents pour la majorité des entretiens suite à des discussions tenues avec notre équipe de direction. Selon nos résultats, suite à la formation aux pratiques du Sensible, les cinq participantes témoignent d’une plus grande proximité et attention à leur corps et d’une meilleure écoute de celui-ci. Cet ancrage corporel de leur présence les informe davantage sur leur mode de vie et d’existence. Il en ressort ainsi des prises de conscience importantes grâce auxquelles les participantes font des choix nouveaux pour une vie plus cohérente et recentrée sur leur intériorité. Par le fait même, elles récupèrent leur pouvoir sur leur vie comme sur leur santé. En outre, parmi les six médecins, quatre ont modifié leur conception de la santé. Celle-ci s’est en effet élargie pour inclure de nouveaux éléments, dont la qualité du rapport à soi et l’accordage entre le corps et la pensée. Le corps semble être une voie souterraine à partir de laquelle se sont réalisées des transformations dans la personne, comme si le corps devenait une interface ayant des effets sur plusieurs facettes de la personne. Ces transformations semblent avoir une influence sur la manière dont celle-ci exerce sa profession, comme si un savoir-être renouvelé de la personne transformait son savoir-faire au sein de sa pratique. Au plan de la qualité de la présence aux autres, il est rapporté que les relations professionnelles se sont améliorées pour la majorité des participantes. Des transformations personnelles semblent avoir eu des effets sur leurs relations professionnelles. Par exemple, tous témoignent d’une meilleure qualité de présence et de disponibilité aux patientes et patients. La plupart signalent l’apprentissage d’une juste distance thérapeutique et, en même temps, d’une relation plus singulière avec chaque patiente et patient. Nous constatons par notre analyse que la relation aux patientes et patients est modifiée aux plans de la communication, du toucher et de l’écoute. Le parcours de formation des étudiantes et étudiants en médecine semble créer des conditions favorisant l’épuisement (Brazeau, Schroeder, Rovi et Boyd, 2010; Colombat, Altmeyer, Barruel, Bauchetet, Blanchard, Colombat et al., 2011; Ishak, Nikravesh, Lederer, Perry, Ogunyemi et Bernstein, 2013; Llera et Durante, 2014; Rodrigues, Albiges et Blanchard, 2012). Certaines interventions de type corps / esprit semblent pouvoir minimiser cet impact (Elder, Rakel, Heitkemper, Hustedde, Harazduk, Gerik et al., 2007; Hewson, Copeland, Mascha, Arrigain, Topol et Fox, 2006; Irving, Park-Saltzman, Fitzpatrick, Dobkin, Chen et Hutchinson, 2014; Maclaughlin, Wang, Noone, Liu, Harazduk, Lumpkin et al., 2011; Motz, Graves, Gross, Saunders, Amri, Harazduk et al., 2012; Rosenzweig, Reibel, Greeson, Brainard et Hojat, 2003; Saunders, Tractenberg, Chaterji, Amri, Harazduk, Gordon et al., 2007). Notre recherche démontre chez nos participantes et notre participant que la formation aux pratiques du Sensible leur a permis de faire plusieurs gains pour leur propre santé. Il semble qu’en amont des apprentissages liés à la profession médicale, une qualité de savoir-être puisse solidifier la personne, ses apprentissages et sa future pratique médicale. Les étudiantes et étudiants en médecine seraient ainsi mieux outillés pour traverser ce cursus de formation exigent et épuisant. Il serait intéressant de reprendre la recherche auprès d’un plus grand nombre de médecins ou d’étudiantes et étudiants en médecine afin d’y observer les éléments de théorisation répétitifs inclus dans la théorisation ancrée de notre étude exploratoire. Ainsi, selon les résultats, il serait alors plus aisé de promouvoir l’apprentissage expérientiel d’approches de type corps / esprit (dont les PS) dans les cursus universitaires en médecine.

Assisting digital forensic analysis via exploratory information visualisation

Background: Digital forensics is a rapidly expanding field, due to the continuing advances in computer technology and increases in data stage capabilities of devices. However, the tools supporting digital forensics investigations have not kept pace with this evolution, often leaving the investigator to analyse large volumes of textual data and rely heavily on their own intuition and experience. Aim: This research proposes that given the ability of information visualisation to provide an end user with an intuitive way to rapidly analyse large volumes of complex data, such approached could be applied to digital forensics datasets. Such methods will be investigated; supported by a review of literature regarding the use of such techniques in other fields. The hypothesis of this research body is that by utilising exploratory information visualisation techniques in the form of a tool to support digital forensic investigations, gains in investigative effectiveness can be realised. Method:To test the hypothesis, this research examines three different case studies which look at different forms of information visualisation and their implementation with a digital forensic dataset. Two of these case studies take the form of prototype tools developed by the researcher, and one case study utilises a tool created by a third party research group. A pilot study by the researcher is conducted on these cases, with the strengths and weaknesses of each being drawn into the next case study. The culmination of these case studies is a prototype tool which was developed to resemble a timeline visualisation of the user behaviour on a device. This tool was subjected to an experiment involving a class of university digital forensics students who were given a number of questions about a synthetic digital forensic dataset. Approximately half were given the prototype tool, named Insight, to use, and the others given a common open-source tool. The assessed metrics included: how long the participants took to complete all tasks, how accurate their answers to the tasks were, and how easy the participants found the tasks to complete. They were also asked for their feedback at multiple points throughout the task. Results:The results showed that there was a statistically significant increase in accuracy for one of the six tasks for the participants using the Insight prototype tool. Participants also found completing two of the six tasks significantly easier when using the prototype tool. There were no statistically significant different difference between the completion times of both participant groups. There were no statistically significant differences in the accuracy of participant answers for five of the six tasks. Conclusions: The results from this body of research show that there is evidence to suggest that there is the potential for gains in investigative effectiveness when information visualisation techniques are applied to a digital forensic dataset. Specifically, in some scenarios, the investigator can draw conclusions which are more accurate than those drawn when using primarily textual tools. There is also evidence so suggest that the investigators found these conclusions to be reached significantly more easily when using a tool with a visual format. None of the scenarios led to the investigators being at a significant disadvantage in terms of accuracy or usability when using the prototype visual tool over the textual tool. It is noted that this research did not show that the use of information visualisation techniques leads to any statistically significant difference in the time taken to complete a digital forensics investigation.

Measuring, Modeling, and Forecasting Volatility and Correlations from High-Frequency Data

This dissertation contains four essays that all share a common purpose: developing new methodologies to exploit the potential of high-frequency data for the measurement, modeling and forecasting of financial assets volatility and correlations. The first two chapters provide useful tools for univariate applications while the last two chapters develop multivariate methodologies. In chapter 1, we introduce a new class of univariate volatility models named FloGARCH models. FloGARCH models provide a parsimonious joint model for low frequency returns and realized measures, and are sufficiently flexible to capture long memory as well as asymmetries related to leverage effects. We analyze the performances of the models in a realistic numerical study and on the basis of a data set composed of 65 equities. Using more than 10 years of high-frequency transactions, we document significant statistical gains related to the FloGARCH models in terms of in-sample fit, out-of-sample fit and forecasting accuracy compared to classical and Realized GARCH models. In chapter 2, using 12 years of high-frequency transactions for 55 U.S. stocks, we argue that combining low-frequency exogenous economic indicators with high-frequency financial data improves the ability of conditionally heteroskedastic models to forecast the volatility of returns, their full multi-step ahead conditional distribution and the multi-period Value-at-Risk. Using a refined version of the Realized LGARCH model allowing for time-varying intercept and implemented with realized kernels, we document that nominal corporate profits and term spreads have strong long-run predictive ability and generate accurate risk measures forecasts over long-horizon. The results are based on several loss functions and tests, including the Model Confidence Set. Chapter 3 is a joint work with David Veredas. We study the class of disentangled realized estimators for the integrated covariance matrix of Brownian semimartingales with finite activity jumps. These estimators separate correlations and volatilities. We analyze different combinations of quantile- and median-based realized volatilities, and four estimators of realized correlations with three synchronization schemes. Their finite sample properties are studied under four data generating processes, in presence, or not, of microstructure noise, and under synchronous and asynchronous trading. The main finding is that the pre-averaged version of disentangled estimators based on Gaussian ranks (for the correlations) and median deviations (for the volatilities) provide a precise, computationally efficient, and easy alternative to measure integrated covariances on the basis of noisy and asynchronous prices. Along these lines, a minimum variance portfolio application shows the superiority of this disentangled realized estimator in terms of numerous performance metrics. Chapter 4 is co-authored with Niels S. Hansen, Asger Lunde and Kasper V. Olesen, all affiliated with CREATES at Aarhus University. We propose to use the Realized Beta GARCH model to exploit the potential of high-frequency data in commodity markets. The model produces high quality forecasts of pairwise correlations between commodities which can be used to construct a composite covariance matrix. We evaluate the quality of this matrix in a portfolio context and compare it to models used in the industry. We demonstrate significant economic gains in a realistic setting including short selling constraints and transaction costs.

Por uma moradia termicamente confortável: proposta de habitação de interesse social com ênfase no conforto térmico

This research covers the topic of social housing and its relation to thermal comfort, so applied to an architectural and urban intervention in land situated in central urban area of Macaíba/RN, Brazil. Reflecting on the role of design and use of alternative building materials in the search for better performance is one of its main goals. The hypothesis is that by changing design parameters and choice of materials, it is possible to achieve better thermal performance results. Thus, we performed computer simulations of thermal performance and natural ventilation using computational fluid dynamics or CFD (Computational Fluid Dynamics). The presentation of the thermal simulation followed the methodology proposed in the dissertation Negreiros (2010), which aims to find the percentage of the amount of hours of comfort obtained throughout the year, while data analysis was made of natural ventilation from images generated by the images extracted from the CFD. From model building designed, was fitted an analytical framework that results in a comparison between three different proposals for dwellings housing model, which is evaluated the question of the thermal performance of buildings, and also deals with the spatial variables design, construction materials and costs. It is concluded that the final report confirmed the general hypotheses set at the start of the study, it was possible to quantify the results and identify the importance of design and construction materials are equivalent, and that, if combined, lead to gains in thermal performance potential.

Efeitos do processo de acreditação nas práticas profissionais dos assistentes sociais em contexto hospitalar: perspectiva de um painel Delphi

A acreditação de um hospital revela-se um instrumento de extrema importância na melhoria da qualidade dos cuidados de saúde. Subjacente a este processo, estão inerentes alterações ao nível organizacional e individual. Este artigo tem como objetivo, identificar os efeitos do processo de acreditação nas práticas profissionais dos assistentes sociais em contexto hospitalar. Neste sentido, realizou-se um painel de peritos, com recurso à técnica Delphi, no qual participaram 12 peritos multidisciplinares e internacionais, tendo sido conseguida obtenção de consenso em três rondas. Dos resultados obtidos emergiram consensos que permite considerar cinco dimensões de ação relevantes face aos efeitos da acreditação nas práticas profissionais dos assistentes sociais, quanto: 1) especificidades da prática; 2) interação de equipas; 3) eficácia profissional; 4) avaliação e monitorização; 5) ganhos em saúde. São dimensões que correspondem a mudanças e que sugerem uma linha de ação que é influenciada, e determinada pelo processo de acreditação no desenvolvimento de uma cultura de melhoria contínua da qualidade da actividade do Serviço Social e do agir profissional. Os resultados obtidos evidenciam que um processo de acreditação tem efeitos diretos e positivos nas práticas dos assistentes sociais.

Plano estratégico de melhoramento nos ovinos Serra da Estrela

A ovelha Serra da Estrela é a principal raça ovina leiteira do país, com 2 variedades: branca (em maior número) e preta. Os principais produtos resultantes da exploração destes animais são o leite (através da sua transformação em Queijo Serra da Estrela) e a carne (através da comercialização de borregos com 30 a 40 dias de idade), ambos de Denominação de Origem Protegida (DOP). Tem sido através da intervenção, a vários níveis, da Associação Nacional de Criadores de Ovinos Serra da Estrela (ANCOSE), que esta raça se tem mantido, nomeadamente, através das acções reprodutivas nas explorações (IA, sincronização de cios, utilização de machos seleccionados) e da recolha e organização da informação genealógica e produtiva (através dos contrastes funcionais de lactação). A informatização integrada e mais racional desta informação, realizada nos últimos anos, tornou possível a execução de outras atividades, nomeadamente, a caracterização genética por análise demográfica e avaliação genética da raça. Com este trabalho pretende-se, através da análise da informação disponível no Livro Genealógico da raça, cedida pela ANCOSE, estudar vários parâmetros que contribuem para a caracterização demográfica da raça Serra da Estrela e a sua avaliação genética. Foram considerados 302911 animais, 401177 partos de 144024 ovelhas, para estimação dos valores genéticos da PROL e 351720 registos de lactações de 131760 ovelhas, para estimação dos valores genéticos da PL150 obtidos em 844 explorações e registados entre 1986 e 2012. Estes resultados auxiliarão na definição das estratégias futuras para a gestão destas populações e à sua utilização em esquemas de selecção desta raça, propondo-se um plano estratégico, com actuações a vários níveis. Nos últimos anos as estratégias de melhoramento genético dos animais por selecção evoluiu consideravelmente. Através das estimativas dos valores genéticos dos animais, obtidas a partir das suas performances e dos seus parentes, pretende-se seleccionar os animais geneticamente superiores para as características mais importantes.

Ganhos em independência funcional no doente com AVC

Introdução – O Acidente Vascular Cerebral (AVC) representa a principal causa de dependência funcional da população adulta portuguesa. Conhecer os fatores que possam aumentar os ganhos em independência funcional é crucial para uma melhoria na abordagem destes doentes. Objetivo – Analisar os ganhos em independência funcional no doente que sofreu AVC considerando a diferença no Índice de Barthel entre a admissão e a alta e desde a alta até à primeira consulta. Métodos – Estudo de coorte retrospetivo, utilizando a base de dados hospitalar para doentes admitidos numa unidade de AVC entre 2010 e 2014. O Índice de Barthel (IB) na admissão, alta e primeira consulta após alta foi usado para calcular ganhos em independência funcional por dia entre a admissão e a alta (diferença entre IB na alta e na admissão dividindo pelo número de dias de internamento) e por semana entre a alta e a primeira consulta (diferença entre IB na primeira consulta e na alta dividindo pelo número de semanas entre a alta e a consulta). Com modelos de regressão linear avaliou-se a influência de fatores demográficos, clínicos e o destino após a alta nos ganhos em independência funcional por dia e por semana, obtendo-se coeficientes de regressão e respetivo intervalo de confiança a 95% (IC95%). Resultados – Nos 483 doentes estudados, a idade mediana é 76 anos, 59,0% são homens, 84,3% têm AVC isquémico e 30,6% foram para o domicílio após a alta. A independência funcional por dia aumentou nos anos mais recentes, particularmente em 2013 em que este parâmetro aumentou 1,164 pontos (com IC95%: 0,192 e 2,135; p=0,019) em comparação com 2010. Também o diagnóstico influenciou os ganhos diários em independência funcional, com LACI e PACI apresentando um aumento estatisticamente significativo de 1,372 pontos (IC95%: 0,324 e 2,421; p=0,010) e de 1,275 pontos (IC95%: 0,037 e 2,514; p=0,044), respetivamente, em comparação com POCI. Relativamente à independência funcional por semana, idades mais avançada e score elevado do IB na alta estão associados a menos ganhos por semana (p<0,001 e p=0,002). Também o destino após alta influencia os ganhos por semana, doentes encaminhados para unidades de convalescença apresentam ganhos de 1,289 pontos (IC95%: 0,661 e 1,917; p<0,001) em comparação com os doentes que foram para o domicílio. iv Conclusões – Houve melhoria na evolução funcional entre a admissão e a alta dos doentes em anos mais recentes sugerindo melhorias nas unidades de AVC. Atenção particular deve ser dada a estes doentes após a alta, particularmente nos de idade mais avançada.

The Impact of a Simulated Clinical Experience on CEGEP Nursing Students’ Perceptions of Self-Efficacy and Achievement

Abstract : Providing high-quality clinical experiences to prepare students for the complexities of the current health-care system has become a challenge for nurse educators. Additionally, there are concerns that the current model of clinical practice is suboptimal. Consequently, nursing programs have explored the partial replacement of traditional in-hospital clinical experiences with a simulated clinical experience. Despite research demonstrating numerous benefits to students following participation in simulation activities, insufficient research conducted within Québec exists to convince the governing bodies (Ordre des infirmières et des infirmiers du Québec, OIIQ; Ministère de L’Éducation supérieur, de la Recherche, de la Science et de la Technologie) to fully embrace simulation as part of nurse training. The purpose of this study was to examine the use of a simulated clinical experience (SCE) as a viable, partial pedagogical substitute for traditional clinical experience by examining the effects of a SCE on CEGEP nursing students’ perceptions of self-efficacy (confidence), and their ability to achieve course objectives. The findings will contribute new information to the current body of research in simulation. The specific case of obstetrical practice was examined. Based on two sections of the Nursing III-Health and Illness (180-30K-AB) course, the sample was comprised of 65 students (thirty-one students from section 0001 and thirty-four students from section 0002) whose mean age was 24.8 years. With two sections of the course available, the opportunity for comparison was possible. A triangulation mixed method design was used. An adapted version of Ravert’s (2004) Nursing Skills for Evaluation tool was utilized to collect data regarding students’ perceptions of confidence related to the nursing skills required for care of mothers and their newborns. Students’ performance and achievement of course objectives was measured through an Objective Structured Clinical Examination (OSCE) consisting of three marked stations designed to test the theoretical and clinical aspects of course content. The OSCE was administered at the end of the semester following completion of the traditional clinical experience. Students’ qualitative comments on the post -test survey, along with journal entries served to support the quantitative scale evaluation. Two of the twelve days (15 hours) allocated for obstetrical clinical experience were replaced by a SCE (17%) over the course of the semester. Students participated in various simulation activities developed to address a range of cognitive, psychomotor and critical thinking skills. Scenarios incorporating the use of human patient simulators, and designed using the Jeffries Framework (2005), exposed students to the care of families and infants during the perinatal period to both reflect and build upon class and course content in achievement of course objectives and program competencies. Active participation in all simulation activities exposed students to Bandura’s four main sources of experience (mastery experiences, vicarious experiences, social persuasion, and physiologic/emotional responses) to enhance the development of students’ self-efficacy. Results of the pre-test and post-test summative scores revealed a statistically significant increase in student confidence in performing skills related to maternal and newborn care (p < .0001) following participation in the SCE. Confidence pre-test and post-test scores were not affected by the students’ section. Skills related to the care of the post-partum mother following vaginal or Caesarean section delivery showed the greatest change in confidence ratings. OSCE results showed a mean total class score (both sections) of 57.4 (70.0 %) with normal distribution. Mean scores were 56.5 (68.9%) for section 0001 and 58.3 (71.1%) for section 0002. Total scores were similar between sections (p =0.342) based on pairwise comparison. Analysis of OSCE scores as compared to students’ final course grade revealed similar distributions. Finally, qualitative analysis identified how students’ perceived the SCE. Students cited gains in knowledge, development of psychomotor skills and improved clinical judgement following participation in simulation activities. These were attributed to the « hands on » practice obtained from working in small groups, a safe and authentic learning environment and one in which students could make mistakes and correct errors as having the greatest impact on learning through simulation.

The need to create awareness towards Cholesterol

Objectives: Nowadays we witness some misinformation towards cholesterol effect in our patients health in mass and social media. The aim of this study was to evaluate the level of awareness towards cholesterol levels in a Portuguese sample and to assess targets for interventions with gains in cardiovascular health.

Language Outcomes of the Play and Language for Autistic Youngsters (PLAY) Project Home Consultation model—An Extended Analysis

The current study is a post-hoc analysis of data from the original randomized control trial of the Play and Language for Autistic Youngsters (PLAY) Home Consultation program, a parent-mediated, DIR/Floortime based early intervention program for children with ASD (Solomon, Van Egeren, Mahone, Huber, & Zimmerman, 2014). We examined 22 children from the original RCT who received the PLAY program. Children were split into two groups (high and lower functioning) based on the ADOS module administered prior to intervention. Fifteen-minute parent-child video sessions were coded through the use of CHILDES transcription software. Child and maternal language, communicative behaviors, and communicative functions were assessed in the natural language samples both pre- and post-intervention. Results demonstrated significant improvements in both child and maternal behaviors following intervention. There was a significant increase in child verbal and non-verbal initiations and verbal responses in whole group analysis. Total number of utterances, word production, and grammatical complexity all significantly improved when viewed across the whole group of participants; however, lexical growth did not reach significance. Changes in child communicative function were especially noteworthy, and demonstrated a significant increase in social interaction and a significant decrease in non-interactive behaviors. Further, mothers demonstrated an increase in responsiveness to the child’s conversational bids, increased ability to follow the child’s lead, and a decrease in directiveness. When separated for analyses within groups, trends emerged for child and maternal variables, suggesting greater gains in use of communicative function in both high and low groups over changes in linguistic structure. Additional analysis also revealed a significant inverse relationship between maternal responsiveness and child non-interactive behaviors; as mothers became more responsive, children’s non-engagement was decreased. Such changes further suggest that changes in learned skills following PLAY parent training may result in improvements in child social interaction and language abilities.